License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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Homebound

Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.1, §30.1.1)

One of Medicare's qualifying criteria for home health care is that the beneficiary is homebound and that the physician certifies that he or she believes the beneficiary is homebound.

The certifying physician's or allowed practitioner's medical records and/or the acute/post-acute care facility's medical records are used to determine the patient eligibility for home health services. This medical record documentation must substantiate the patient's need for skilled services, and their homebound status. The home health agencies documentation, such as the initial and/or comprehensive assessment of the patient can be incorporated into the certifying physician's medical record and used to support the patient's homebound status and need for skilled care. For additional information, refer to the "FTF Documentation" section on the CGS "Home Health Face-to-Face (FTF) Encounter" Web page.

The beneficiary shall be considered homebound if the following two criteria are met.

Criteria-One:

The beneficiary must either:

Because of illness or injury, need the aid of supportive devises such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence
OR
Have a condition such that leaving his or her home is medically contraindicated.

Criteria-Two:

There must exist a normal inability to leave home;
AND
Leaving home must require a considerable and taxing effort.

The patient may be considered homebound if the absences from the home are infrequent or for periods of relative short durations, or are for the need to receive health care treatment. Examples may be attendance at adult day care centers, ongoing outpatient kidney dialysis or outpatient chemotherapy or radiation therapy. For examples of homebound status, refer to the Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7, §30.1.1)

Place of Residence – Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §30.1.2)
Cognitive or Psychiatric Conditions
Documentation of Homebound Status

Reviewed: 12.10.21

License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

AMA Disclaimer of Warranties and Liabilities.

CMS Disclaimer

POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

Homebound

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